Magazine article USA TODAY

On the Cusp of a Cure: We Can Beat Alzheimer's Crushing Burdens on Families and Society-And Help May Be Here Soon

Magazine article USA TODAY

On the Cusp of a Cure: We Can Beat Alzheimer's Crushing Burdens on Families and Society-And Help May Be Here Soon

Article excerpt

I HAVE DEVOTED my professional life to finding treatments---and, I hope, someday cures--for malignant brain tumors, because I always have thought nothing could be worse than a diagnosis of brain cancer. The brain and its thought- and emotion-processing centers give us our unique personalities and define who we are. Having our sense of self taken away in a life-and-death battle is hard to fathom.

Yet, as cruel as brain cancer is, I have come to believe that Alzheimer's disease is worse. I know firsthand its devastating effects because it took my mother's life just before Memorial Day. For the past few years, I could do nothing but watch as this bright, retired school teacher lost the ability to communicate, care for herself, or recognize her family.

With brain minors, as long as we can keep the cancer in remission, a patient will have a fairly good quality of life until the very end. The worst time usually is a matter of just a few months, so the period of "good" versus that of "not good" is better for cancer than Alzheimer's patients; they face a long steady decline, usually lasting four to eight years--sometimes as long as two decades.

Watching my mother's struggle and seeing and feeling the effects on me and our family, I know that we must find answers to the malicious riddles of Alzheimer's. My passion is fueled by my inability to intervene. It is too late for my mother, but I believe we soon can have therapies in place for my kids' and grandkids' generations.

Beyond the personal level, Alzheimer's disease strains our society and health care system. If we fail to solve this problem--as the population continues to age--Alzheimer's alone has the potential to bankrupt Medicare. The Alzheimer's Association says 75% of those afflicted will be admitted to nursing homes by age 80, compared with four percent of the general population. The government, aware of the dire forecasts, is taking action: Health and Human Services Secretary Kathleen Sebelius has announced the creation of a National Alzheimer's Plan focused on creating treatments and providing help for patients and families. Critical problems exist in our understanding of, and approach to, Alzheimer's. Addressing them gives us the opportunity to reverse our approaches.

We now diagnose this disease when people develop memory loss---when they start forgetting how to get to their friend's house, where they parked their car or left their keys. However, the disease process begins 10, 15, or 20 years before symptoms start. By the time we see memory loss, patients already have lost 40% to 50% of their brain cells, which, essentially, is at the end stage of the disease.

Our diagnostic tools also are crude, little more than IQ tests to detect problems with memory and comprehension. The way we diagnose the disease inherently is inaccurate, so what we call Alzheimer's may not always be. It may be vascular dementia from ministrokes that have occurred over time or frontotemporal dementia, which is totally different. Several disorders and disease processes can cause cognitive issues that may look like those associated with Alzheimer's.

When Dr. Alois Alzheimer in 1906 looked during autopsy procedures at brains of patients who died after suffering a specific type of mental confusion and deterioration, he found unusual clumps and fibers of proteins. These sticky substances---plaques consisting of beta-amyloid protein and neurofibrillary tangles of tau protein--remain the hallmark of Alzheimer's disease. The proteins do not show up on CT or MRI scans. Although early detection is an area of great research interest, we still have no practical, humane, or accurate way to view these plaques while a patient lives. Just as in 1906, autopsy provides the only definitive diagnosis of Alzheimer's. To advance our care, we must find a way to make the diagnosis early and accurately.

At Cedars-Sinai Medical Center, we have discovered that beta-amyloid protein plaques occur not only in the brain, but in the retina in the back of the eye. …

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